Name *

First Name

Last Name

Phone *

(###)

###

####

USAW Wrestling Leader Card *

Have you ever, or do you currently have a Wrestling Leader Card?

Yes

No

Requirements *

You would need to be willing to submit to a background check, complete Safe Sport Training, and provide a negative TB Test, as well as potentially other training or requirements for this position. Are you willing to do this?

Yes

No

Preferred Team *

Pick a team you would like to be considered for, or state no preference.

Lakewood

San Miguel

Bishop

Vargas

Ellis

Katherine Smith

Holly Oaks

No Preference